Disseminated cryptococcosis in a patient with Nephrotic syndrome

Abstract

Disseminated cryptococcosis mainly occurs in patients with impaired cell mediated immunity. We present a case of disseminated cryptococcosis in a non-HIV patient with nephrotic syndrome who never received immunosuppression. Cultures of bone marrow aspirate, cerebrospinal fluid analysis and histology of skin lesions were all consistent with Cryptococcus neoformans infection. Treatment with amphotericin B followed by fluconazole was successful and in the course of two months when, the skin nodules disappeared. Key words: Cryptococcosis, nephrotic syndrome, immunocompromised hostWith the increasing number of immunocompromised patients in the last decade, the systemic mycoses are increasing in importance as opportunistic infections. The etiologic microorganisms vary depending upon the type of immune dysfunction. Definitive diagnosis is often difficult to establish and usually requires invasive biopsy.Cryptococcosis or Torulosis first described by Busse in 1894, is an uncommon systemic mycosis caused by the encapsulated yeast Cryptococcus neoformans. Approximately 85% of patients with cryptococcosis have impaired cell mediated immunity. Acquired immuno-deficiency syndrome (AIDS) associated cryptococcal infections now account for 80-90% of all patients with cryptococcosis. 1Here we report a case of disseminated cryptococcosis in a non-HIV patient with nephrotic syndrome who was never treated with immunosuppressive drugs. We believe this case to be the first report of disseminated cryptococcosis occurring in a nephrotic syndrome patient without AIDS or medical immunosuppression. Case ReportA 37-year-old farmer, who was diagnosed to have nephrotic syndrome, presented with one month history of low grade fever, lethargy, weight loss and increasing body swelling. Past medical history was significant for nephrotic syndrome, secondary to membranous glomerulonephritis two years back. He was treated with a diuretic and ACE inhibitor combination and never required steroids at any stage. He was however, lost to follow up for a year and was finally back with On examination, he appeared ill, temperature was 100 o F, blood pressure 160/90 mmHg, he was pale and had generalized oedema. General examination revealed multiple, variable sized, discrete, nontender subcutaneous nodules (Fig. 1)

Successful Management of Cryptococcal Meningitis and Bone Marrow Infiltration in a Young HIV/AIDS Patient: A Case Report and Review of the Literature

“…We identified seven English language case reports published since 1990 that specifically reported patients positive for Cryptococcus in the bone marrow [1–7]. Two studies were excluded as they were case reports of non-HIV patients, and two were excluded as they did not specify the cryptococcosis treatment regimen [1, 2, 5, 6]. We summarize the key features of three cases of Cryptococcus infection of the bone marrow in the literature in addition to this case report.…”

Fulminant intracranial hypertension due to cryptococcal meningitis in a child with nephrotic syndrome

“…described disseminated cryptococcosis in a patient with nephrotic syndrome, who was not on immunosuppressive therapy. [3]Our patient, however, had been on long-term low-dose steroids.…”

Cryptococcosis as a cause of nephrotic syndrome? A case report and review of the literature

“…The glomerular permeability factor is yet to be identified, but it may be released by T-cells in response to microorganisms, drugs or neoplasms. Second, we gathered several cryptococcal cases related to NS [ [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ], in some of them the proteinuria actually responded to anti-fungal treatment ( Table 1 ) [ [11] , [12] , [13] , 16 ]. There is growing information regarding the association between cryptococcal infection and idiopathic NS [ 19 ].…”